Spine Journal最新文献

{"title":"The biomechanical impact of cement volume and filling pattern for augmented pedicle screws using various density testing blocks.","authors":"Ming-Kai Hsieh, Weng-Pin Chen, De-Mei Lee, Yun-Da Li, Fu-Cheng Kao, Hao-Hsin Chiang, Tsung-Ting Tsai, Tsai-Sheng Fu, Po-Liang Lai, Ching-Lung Tai","doi":"10.1016/j.spinee.2025.01.018","DOIUrl":"10.1016/j.spinee.2025.01.018","url":null,"abstract":"<p><strong>Background context: </strong>Patients with osteoporosis experience a higher risk of pedicle screw loosening and failure, making PMMA bone cement augmentation a common recommendation to increase stability. However, there is ongoing debate about the ideal cement volume, filling pattern, and measurable increase in stability that cement provides.</p><p><strong>Purpose: </strong>This aim of this study is to clarify the impact of cement volume and filling pattern on the stability of pedicle screws in synthetic bone blocks of varying density.</p><p><strong>Study design: </strong>We examined the effects of different volumes of PMMA cement on screw stability by using synthetic bone blocks with densities of 7.5 pcf, 15 pcf, and 30 pcf to simulate human vertebral cancellous bone with osteoporosis, osteopenia, and normal bone density. Two filling patterns were compared: a tip cement cloud and a surrounding cement cloud.</p><p><strong>Methods: </strong>We tested solid screws, cannulated screws without side holes, and cannulated screws with 4 side holes. Cement volumes of 2 cc, 3 cc, and 4 cc were injected, and the pullout strength was measured using an Instron testing machine. The samples were categorized into the control (no cement) group, S group (solid screws with prefilling), C1 group (cannulated screws without side holes), and C5 group (cannulated screws with 4 side holes). Among these, the C1 group exhibited a cement cloud at the tip, while the S and C5 groups showed a surrounding cement cloud.</p><p><strong>Results: </strong>Adding an extra 1 cc of cement (from 2 cc to 3 cc, or 3 cc to 4 cc) significantly increased the pullout strength by 10% in 7.5 pcf bone, 47% in 15 pcf bone, and 34% in 30 pcf bone and doubling the cement volume resulted in even greater increases. Regardless of the injected volume, cement augmentation substantially increased the pullout strength in osteoporotic bone compared with noncemented screws in osteopenic bone. For a given cement volume, the anchorage power was greater for the surrounding cement cloud pattern than for the tip cement cloud pattern.</p><p><strong>Conclusion: </strong>Although the addition of more cement increases the pullout strength, excessive augmentation in osteoporotic bone is unnecessary. The filling pattern is crucial; a larger contact area in the surrounding cement cloud enhances screw stability more effectively than the tip cement cloud does.</p><p><strong>Clinical significance: </strong>While adding more cement increases pullout strength, excessive augmentation in osteoporotic bone is unnecessary. The filling pattern rather than the screw design is a crucial determinant of screw stability.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical versus nonsurgical treatment of thoracolumbar burst fractures in neurologically intact patients: a cost-utility analysis.","authors":"Charlotte Dandurand, Cumhur F Öner, Klaus John Schnake, Richard J Bransford, Greg D Schroeder, Nicolas Dea, Mark R Phillips, Alexander Joeris, Mohammad El-Sharkawi, Shanmuganathan Rajasekaran, Lorin M Benneker, Jin W Tee, Eugen Cezar Popescu, Jérôme Paquet, John C France, Alexander R Vaccaro, Marcel F Dvorak","doi":"10.1016/j.spinee.2025.01.030","DOIUrl":"10.1016/j.spinee.2025.01.030","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Many efforts have been made to determine what is the best treatment strategy for neurologically intact patients with TL burst fractures: surgery or nonoperative management. Studies comparing clinical outcomes have produced mixed and inconclusive results creating lack of consensus in the expert community.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Therefore, it is necessary to explore other important components of healthcare such as economics to settle this controversial debate. The goal of the current study was to perform a cost-utility analysis comparing surgical treatment to nonoperative treatment for neurologically intact TL burst fractures (AOSpine classification types A3 and A4) from a societal perspective in a multicenter and international setting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;We performed a cost-utility analysis from a societal perspective comparing the cost-utility of surgical treatment versus nonsurgical treatment of thoracolumbar (TL) burst fractures in neurologically intact patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Patient demographics and all clinical and outcome data were taken from an observational, prospective multicenter cohort study comparing surgical versus nonsurgical treatment of TL burst fractures in neurological intact patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;The ICER was calculated comparing surgical versus nonsurgical treatment for the full analysis population with a 1-year time horizon, two-year time horizon as well as the working-life time horizon. Costs were taken from the clinical study, patient diaries with productivity loss documented, current scientific literature in addition to national and international healthcare costing guidelines and databases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The mean difference in cost between the two treatment groups were calculated, firstly by applying the central limit theorem, and secondly by using bootstrapping. To calculate the average cost per patient in each treatment group, the Kaplan-Meier Sample Average (KMSA) estimator was used in order to take account of the censored patients. To evaluate the derived models and to explore uncertainty, sensitivity analysis was used.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Eleven sites from different regions (North America, Europe, Middle east, and Asia) completed the recruitment and follow-up for 213 patients. One hundred and thirty patients were treated surgically (61.0%) and eighty-three patients (39.0%) were treated nonsurgically. At 1-year, the ICER for surgical treatment was $191,648.00 USD per QALY. Compared to a willingness to pay threshold of $100,000, surgical treatment was not cost-effective within the 1-year timeframe. At 2-years, the nonsurgical group had visited the surgeon or general practitioner more often (0.31 vs. 0.25). The nonsurgical group had visited physiotherapist and other allied health more often (3.68 vs. 1.68). The utilization of NSAIDs and opioids remained higher in t","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and cost-effectiveness of mechanical diagnosis and treatment combined with transforaminal epidural steroid injections for patients on a waiting list for surgery for a chronic lumbar herniated disc: a randomized controlled trial and economic evaluation.","authors":"Elizabeth N Mutubuki, Hans Van Helvoirt, Johanna M Van Dongen, Mariska Van 't Klooster, Ângela Jornada Ben, Carmen LA Vleggeert-Lankamp, Frank Huygen, Maurits W Van Tulder, Hanneke Ahj Klopper-Kes, Servan Rooker, Mathieu Lenders, Niels A Van Der Gaag, Carel Fe Hoffmann, Paul Leliefeld P, Elmar M Kleinjan, Marije Pol, Raymond Wjg Ostelo","doi":"10.1016/j.spinee.2025.01.012","DOIUrl":"10.1016/j.spinee.2025.01.012","url":null,"abstract":"<p><strong>Background context: </strong>Mechanical Diagnosis and Treatment (MDT) and epidural steroid injections have the potential to reduce pain and disability in sciatica patients and prevent surgery. However, data on their combined influence in reducing the amount of sciatica surgeries is lacking.</p><p><strong>Purpose: </strong>To assess if a combination therapy (MDT and TESIs), administered while being on the waiting list for lumbar herniated disc surgery, is effective and cost-effective compared to no intervention (ie, usual care).</p><p><strong>Study design: </strong>Multicentre randomized controlled trial with economic evaluation and 1-year follow-up.</p><p><strong>Patient sample: </strong>Seventy-two adult patients on a waiting list for lumbar herniated disc surgery.</p><p><strong>Outcome measures: </strong>Primary outcome was undergoing lumbar disc surgery during follow-up (yes/no). Secondary outcomes included back and leg pain intensity (NPRS), physical functioning (RMDQ-23), self-perceived recovery (GPE), and health-related quality of life (EQ-5D-5L). Total societal and total healthcare were measured.</p><p><strong>Methods: </strong>Participants were randomly assigned to combination therapy (intervention group, n=34) or no intervention (control group, n=38).</p><p><strong>Results: </strong>Twenty-nine out of 38 control group patients and 11 out of 34 intervention group patients received surgery. The adjusted odds ratio of receiving surgery in the intervention group compared to the control group was 0.09 (95% CI, 0.02-0.35) and the adjusted risk ratio 0.29 (95% CI, 0.08-0.69). There were no differences in clinical effects between both groups. Surgical, total societal, and total healthcare costs were on average €1,969, €1,754, and €2,363 lower in the intervention group, respectively. The combination therapy's probability of being cost-effective was moderate (≤0.66) across a range of willingness-to-pay values from €20,000/QALY to €80,000/QALY, from a societal perspective.</p><p><strong>Conclusion: </strong>Patients on the waiting list for lumbar disc surgery and who are open to postpone surgery, may benefit from the combination therapy intervention.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impacts of hip osteoarthritis on spinal sagittal alignment and surgical outcomes in patients with adult spinal deformity: evidence from meta-analysis and 2-sample mendelian randomization.","authors":"Dongfan Wang, Ashish D Diwan, Xiaolong Chen, Shibao Lu","doi":"10.1016/j.spinee.2025.01.021","DOIUrl":"10.1016/j.spinee.2025.01.021","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;A considerable proportion of patients with adult spinal deformity (ASD) have concomitant hip osteoarthritis (HOA). However, no studies have systematically summarized the impacts of HOA on ASD patients, either radiologically or clinically.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To compare the spinal sagittal alignment parameters pre- and postoperatively, along with patient-reported outcomes and complications following surgery in ASD patients with or without severe HOA (Kellgren-Lawrence grade 3-4).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Systematic review and meta-analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We searched the PubMed, Embase, Scopus, Cochrane Library, Google scholar, ClinicalTrials.gov, ProQuest Dissertations and These, and Open Grey for articles with a publication cutoff of July 28, 2024. The inclusion criteria were: (1) comparative studies of ASD patients with and without severe HOA, (2) outcomes reported as spinal radiographic outcomes (such as pelvic tilt (PT), sacrofemoral angle (SFA), knee angle (KA), or sagittal vertical axis (SVA), etc.), patient-reported outcomes (such as SRS-22r, ODI, VR-12 PCS, etc.), and complications (such as proximal junctional kyphosis, pseudarthrosis, reoperation, etc.), and (3) randomized controlled trials and observational studies published in English. The exclusion criteria were (1) reviews, case series, case reports, letters, and conference reports, (2) in vitro biomechanical studies and computational modelling studies, (3) no report on study outcomes, and (4) studies with &lt;10 patients per group. Additionally, a 2-sample mendelian randomization (MR) study using genetic variants associated with HOA as instrumental variables was conducted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Four observational studies with a total of 891 ASD patients (672 minimal HOA, 219 severe HOA) were included. Based on our meta-analysis, ASD patients with severe HOA exhibited significantly lower PT (95% CI: 0.09-0.57) and SFA (5% CI: 0.31-0.68), along with higher KA (95% CI: -0.52 to -0.19), SVA (95% CI: -0.75 to -0.41), global sagittal angle (95% CI: -0.71 to -0.16), and posterior pelvic shift (95% CI: -0.93 to -0.25) than those with minimal HOA. Furthermore, concomitant severe HOA was associated with higher postoperative SVA, worse VR-12 PCS, and increased risk of pseudarthrosis and reoperation based on a review of the literature. The MR study indicated a causal association between HOA and intervertebral disc degeneration related traits, including early lumbar prolapse (95% CI: 1.08-1.46), intervertebral disc disorders (95% CI: 1.07-1.32), and low back pain (95% CI: 1.02-1.17). Moreover, HOA was proven to relate to sarcopenia related traits, including usual walking pace (95% CI: -0.04 to -0.02) and hand grip strength (95% CI: -0.06 to -0.01).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Radiologically, concomitant HOA in patients with ASD appears to be associated with limited pelvic compensatory capacity","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The intradiscal pressure of the lumbar spine is affected by intervertebral disc degeneration, age, level, and motion direction: evaluation of an in vitro database comprising 107 specimens.","authors":"Christian Liebsch, Hans-Joachim Wilke","doi":"10.1016/j.spinee.2025.01.024","DOIUrl":"10.1016/j.spinee.2025.01.024","url":null,"abstract":"<p><strong>Background context: </strong>Intradiscal pressure (IDP) is a fundamental parameter for the estimation of loads and muscle forces acting on the spine and a major biomechanical indicator for various spinal pathologies.</p><p><strong>Purpose: </strong>To investigate primary effects of intervertebral disc degeneration, age, sex, segmental level, and motion direction on lumbar IDP using a large in vitro data collective.</p><p><strong>Study design: </strong>Evaluation of an internal database comprising 107 human functional spinal units of L2-L3, L3-L4, and L4-L5 from 68 donors (19-74 years, mean 50±12 years, 42% female).</p><p><strong>Methods: </strong>All specimens had been loaded with pure moments of 7.5 Nm in flexion/extension, lateral bending, and axial rotation and IDP had been measured using flexible pressure sensors. Disc degeneration was assessed from radiographs using a validated classification system.</p><p><strong>Results: </strong>IDP was significantly (p<.05) reduced for degeneration grades 1 (mild degeneration) and 2 (moderate degeneration) compared to grade 0 (no degeneration) in all motion directions and for the intrinsic pressure (INTP) without any loading (moment of 0 Nm). IDP significantly (p<.05) negatively (-0.69≤r≤-0.45) correlated with age and was significantly (p<.05) reduced for an age >40 years in all motion directions and for the INTP. Sex did not significantly (p<.05) affect the IDP. The IDP at L4-L5 level was significantly (p<.05) reduced compared to the IDP at L2-L3 level in all motion directions and for the INTP and significantly (p<.05) lower in axial rotation and for the INTP compared to flexion/extension and lateral bending.</p><p><strong>Conclusions: </strong>This study revealed that more degenerated discs and discs from elderly donors exhibit low or even negative intradiscal pressure, overall questioning in vitro and in vivo IDP measurements which disregard the degenerative condition of the intervertebral discs and the age of the donors and participants.</p><p><strong>Clinical significance: </strong>Increasing disc degeneration and age as well as more distal lumbar level are associated with decreased IDP of the lumbar spine, possibly less maintaining the load sharing capacity and thus representing risk factors for spinal pathologies.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated measurement of pelvic parameters using convolutional neural network in complex spinal deformities: overcoming challenges in coronal deformity cases.","authors":"Dong-Ho Kang, Ye-Jin Jeong, Sung Taeck Kim, Younguk Kim, Bong-Soon Chang, Hyoungmin Kim, Sam Yeol Chang, Du Hyun Ro","doi":"10.1016/j.spinee.2025.01.020","DOIUrl":"10.1016/j.spinee.2025.01.020","url":null,"abstract":"<p><strong>Background context: </strong>Accurate and consistent measurement of sagittal alignment is challenging, particularly in patients with severe coronal deformities, including degenerative lumbar scoliosis (DLS).</p><p><strong>Purpose: </strong>This study aimed to develop and validate an artificial intelligence (AI)-based system for automating the measurement of key sagittal parameters, including lumbar lordosis, pelvic incidence, pelvic tilt, and sacral slope, with a focus on its applicability across a wide range of deformities, including severe coronal deformities, such as DLS.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Patient sample: </strong>A total of 1,011 standing lumbar lateral radiographs, including DLS.</p><p><strong>Outcome measure: </strong>Interclass and intraclass correlation coefficients (CC), and Bland-Altman plots.</p><p><strong>Methods: </strong>The model utilizes a deep-learning framework, incorporating a U-Net for segmentation and a Keypoint Region-based Convolutional Neural Network for keypoint detection. The ground truth masks were annotated by an experienced orthopedic specialist. The performance of the model was evaluated against ground truth measurements and assessments from two expert raters using interclass and intraclass CC, and Bland-Altman plots.</p><p><strong>Results: </strong>In the test set of 113 patients, 39 (34.5%) had DLS, with a mean Cobb's angle of 14.8°±4.4°. The AI model achieved an intraclass CC of 1.00 across all parameters, indicating perfect consistency. Interclass CCs comparing the AI model to ground truth ranged from 0.96 to 0.99, outperforming experienced orthopedic surgeons. Bland-Altman analysis revealed no significant systemic bias, with most differences falling within clinically acceptable ranges. A 5-fold cross-validation further demonstrated robust performance, with interclass CCs ranging from 0.96 to 0.99 across diverse subsets.</p><p><strong>Conclusion: </strong>This AI-based system offers a reliable and efficient automated measurement of sagittal parameters in spinal deformities, including severe coronal deformities. The superior performance of the model compared with that of expert raters highlights its potential for clinical applications.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visceral fat obesity predicts ossification of the posterior longitudinal ligament: annual health examination data-based evidence.","authors":"Soya Miura, Yoshinao Koike, Tsutomu Endo, Masahiko Takahata, Hideki Sudo, Ken Kadoya, Masahiro Kanayama, Ryo Fujita, Shotaro Fukada, M Alaa Terkawi, Katsuhisa Yamada, Takashi Ohnishi, Daisuke Ukeba, Hiroyuki Tachi, Yuichi Hasegawa, Misaki Ishii, Norimasa Iwasaki","doi":"10.1016/j.spinee.2025.01.032","DOIUrl":"10.1016/j.spinee.2025.01.032","url":null,"abstract":"<p><strong>Background context: </strong>Recent studies have demonstrated a close association between the development of ossification of the posterior longitudinal ligament (OPLL) and obesity. However, the association between OPLL and visceral fat obesity, which is prevalent in the Asian population, remains unexplored.</p><p><strong>Purpose: </strong>To examine the impact of visceral fat obesity on the development of asymptomatic OPLL.</p><p><strong>Study design: </strong>Single-institution cross-sectional study.</p><p><strong>Patient sample: </strong>Between 2020 and 2021, data were collected from 249 Japanese individuals (147 men and 102 women) who underwent computed tomography (CT) to assess both the visceral fat content and OPLL.</p><p><strong>Outcome measures: </strong>We assessed patient background information, serum data, and CT images, including the abdominal circumference (cm), total fat area (cm²), visceral fat area (cm²), and subcutaneous fat area (cm²) at the umbilicus level. OPLL localization was assessed using whole-spine CT images.</p><p><strong>Methods: </strong>The individuals were categorized into 4 groups based on obesity and visceral fat: nonobesity without visceral fat (n=85), obesity without visceral fat (n=18), nonobesity with visceral fat (n=44), and obesity with visceral fat (n=102). OPLL was classified as localized or diffuse when present in the cervical spine alone or in the cervical and thoracic spine, respectively. The prevalence of each type of OPLL was compared between the groups. Multivariable analysis was conducted to calculate the effect size of body mass index (BMI) on the prevalence of OPLL, comparing the high and low visceral fat groups.</p><p><strong>Results: </strong>The obesity with visceral fat group exhibited a significantly higher proportion of diffuse OPLL than did the nonobesity without visceral fat group (27.5% vs. 7.1%, p<.001). The effect size of BMI for the occurrence of diffuse OPLL was 2.1 times greater in the high visceral fat group (odds ratio [OR], 3.12; 95% confidence interval [CI], 1.66-5.87) than in the low visceral fat group (OR, 1.44; 95% CI, 0.64-3.22).</p><p><strong>Conclusions: </strong>Our data show that visceral fat, in conjunction with BMI, influences the occurrence of OPLL in the Japanese population. This supports the hypothesis that systemic metabolic disorders share a disease mechanism with OPLL and indicates that the high prevalence of OPLL in Japan may be attributed to physical characteristics that promote visceral fat accumulation.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maximizing screw length in expandable lateral lumbar interbody spacers with integrated fixation may obviate the need for supplemental pedicle screws.","authors":"Gregory M Malham, Wenhai Wang, Joshua P McGuckin, Jonathan M Mahoney, Dean T Biddau, Brandon S Bucklen","doi":"10.1016/j.spinee.2025.01.035","DOIUrl":"10.1016/j.spinee.2025.01.035","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Lateral lumbar interbody fusion (LLIF) is a minimally invasive surgical technique that provides a wide footprint interbody cage for correction of lumbar coronal and sagittal deformity. Traditional spinal interbody fusion procedures utilize pedicle screws and rods for additional stability. An expandable lateral titanium interbody cage with an integrated lateral fixation (eLLIFp) device provides a stand-alone LLIF that is intended to function autonomously. This may reduce the complexity of the surgery and the potential risks associated with supplemental posterior instrumentation. The minimum-acceptable screw length to promote adequate biomechanical fixation and stability for a stand-alone eLLIFp has not been determined.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To investigate the effective ratio (of screw length/cage length) of a stand-alone eLLIFp construct that provides adequate biomechanical fixation and stability as compared to the eLLIFp with supplemental bilateral pedicle screw-rod fixation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;In vitro cadaveric biomechanical testing and finite element modeling.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Eight fresh-frozen human cadaveric lumbar spine specimens (L2-5) were used.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Range-of-motion (ROM) measurements of intact and treated specimens with simulated stresses within the construct and surrounding bone during flexion-extension (FE), lateral bending (LB), and axial rotation (AR).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Specimens with similar age and DEXA scores were selected. ROM of intact specimens was measured before treatment with LLIF at L3-4. Specimens were treated with expandable lateral cages with integrated fixation (stand-alone eLLIFp) or eLLIFp with supplemental posterior fixation using bilateral pedicle screws and rods (eLLIFp + BPS). ROM was measured using a custom-built 6-degrees-of-freedom motion simulator (±7.5Nm) and normalized as a percentage of intact. Four patient-specific lumbar functional spinal unit finite element models (FEMs) were developed, validated, and then instrumented with eLLIFp stand-alone devices. The integrated screw lengths were varied to achieve screw-to-cage length ratios of 0.6, 0.75 and 0.9. Stresses were compared among the constructs under a 7.5Nm pure moment load in FE, LB, and AR.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The stand-alone and posteriorly supplemented eLLIFp constructs were not sensitive to the ratio during FE and LB (with only a 4%-9% change in motion trends from low-to-high ratios, relative to intact). Independent of ratio, these constructs had minimal differences in FE and LB motion. However, during AR both constructs were sensitive to the ratio showing greater stability and less variability in performance with higher ratios (≥0.65). Regression analysis revealed that posteriorly supplemented eLLIFp constructs had a linear 13% reduction in AR motion as the ratio increased from low-to-high","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The prevalence and multifactor analysis of thoracolumbar fasciitis in patients with osteoporotic vertebral compression fractures.","authors":"Runsen Chen, Shuao Lei, Guangzhou Li","doi":"10.1016/j.spinee.2025.01.038","DOIUrl":"10.1016/j.spinee.2025.01.038","url":null,"abstract":"<p><strong>Background context: </strong>Previous studies have reported that postoperative residual pain of osteoporotic vertebral compression fractures (OVCFs) may be associated with thoracolumbar fasciitis. However, to our knowledge, few reports have analyzed the prevalence and risk factors of thoracolumbar fasciitis in OVCFs.</p><p><strong>Purpose: </strong>To investigate the prevalence and identify the risk factors of thoracolumbar fasciitis in OVCFs.</p><p><strong>Study design/setting: </strong>A retrospective study.</p><p><strong>Patient sample: </strong>We reviewed OVCFs patients from January 2018 to December 2022.</p><p><strong>Outcome measures: </strong>Data on factors that could affect the occurrence of thoracolumbar fasciitis in OVCFs, such sex, age, type of trauma (apparent trauma and no evident trauma), body mass index (BMI), duration of pain, and comorbidities, were collected from the patients' medical records. Fat infiltration in the lumbar paraspinal muscles, fracture segments, number of vertebral fractures, paravertebral muscle area (PMA), psoas area (PA), relative PMA (rPMA) and relative PA (rPA) were radiologically examined.</p><p><strong>Methods: </strong>Patients with OVCFs were divided into thoracolumbar fasciitis (TF) group and nonthoracolumbar fasciitis (NTF) group. Independent t-tests and chi-square tests were used in univariate analysis between 2 groups. To assess independent risk factors, multivariate logistic regression analysis was conducted on variables significant at p<.05 in univariate analysis.</p><p><strong>Results: </strong>In this retrospective study, a total of 602 OVCFs patients were enrolled. Among 602 OVCFs patients, 286 were diagnosed with thoracolumbar fasciitis (TF group) and the rest into NTF group. In the univariate analysis, the related factors of thoracolumbar fasciitis in OVCFs included age (p=.001), rPMA (p<.001), fat infiltration in the lumbar paraspinal muscles (mild, moderate and severe infiltration) (p<.001), BMI (p=.002), types of trauma (no evident and apparent trauma) (p=.038) and hypertension (p=.04). In the multivariate analysis, the statistically significant risk factors of thoracolumbar fasciitis in OVCFs included age [odds ratio (OR)=1.036, p=.004], rPMA (OR=5.793, p<.001), severe paravertebral muscle fat infiltration (OR=2.759, p<.001), BMI (OR=1.081, p=.002) and apparent trauma (OR=1.643, p=.006).</p><p><strong>Conclusion: </strong>The prevalence of thoracolumbar fasciitis in OVCFs is 47.51%. Independent risk factors identified for thoracolumbar fasciitis in OVCFs included advanced age, increased rPMA, severe paravertebral muscle fat infiltration, higher BMI and apparent trauma.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three different screw trajectories in single segment fixation: a finite element analysis and biomechanical study.","authors":"Yuetian Wang, Haoran Liu, Bingxu Li, Shijun Wang, Haolin Sun","doi":"10.1016/j.spinee.2025.01.029","DOIUrl":"10.1016/j.spinee.2025.01.029","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Backgroud context: &lt;/strong&gt;Conventional pedicle screw (CPS) fixation in osteoporotic spines presents significant challenges. Cortical bone trajectory (CBT) screws can enhance screw holding power by increasing contact with cortical bone. However, the standard CBT (S-CBT) screws may encounter a series of problems such as stress concentration and diminished fatigue resistance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;The S-CBT screw technique has been modified to accommodate longer screws, and the biomechanical behaviors of this modified CBT (M-CBT) screw technique were investigated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A finite element analysis and biomechanical cadaveric study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A validated nonlinearly finite element model spanning L1-S1 was employed in this study. Three L4-5 fusion models, namely CPS, M-CBT, and S-CBT, were generated using interbody fusion cages and different screw fixations. Next, the models were subjected to loading protocols to simulate flexion, extension, lateral bending, and rotation motion. The range of motion (ROM) and peak von Mises stress of the Cage, rods, screws, and intervertebral discs were analyzed. Besides, 3 types of cadaveric lumbar fusion modes were constructed using diverse screw trajectories. These models were cycled 10,000 times to measure the vertebral body displacement. Afterward, the individual screws were subjected to axial pull-out tests, and the maximum pulling-out force was documented. Finally, the data from the 3 fusion models were compared.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Regarding 6 degrees of freedom movements, the 3 fixation models significantly increased the ROM of the adjacent segments (L3-4 and L5-S1) (p&lt;.01). However, the differences in ROM increments among the 3 models were not statistically significant (p=.815). The peak von Mises stress of the cage for the M-CBT model was lower by -1.06%, 37.75%, 10.28%, and 17.55% compared with the S-CBT model during flexion, extension, right bending, and left rotation directions, respectively. Similarly, the peak von Mises stress of L5 screws for the M-CBT model was lower by 50.57%, 59.98%, 47.29%, 64.07%, 63.24%, and 50.45% compared with S-CBT during flexion, extension, left bending, right bending, left rotation, and right rotation, respectively. In the biomechanical test, the fatigue displacement results revealed that the displacement of M-CBT model was intermediate between the S-CBT and CPS models under both maximum and minimum forces, with statistically significant differences (p&lt;.05). Additionally, the results of the antipullout test following fatigue loads demonstrated that the M-CBT group exhibited the highest maximum pull-out force (Fmax) (381.80 [119.00, 852.20]), followed by the CPS group (329.10 [117.00, 507.80]) and the S-CBT group (321.50 [196.60, 887.20]), but the differences were not statistically significant (p=.665) in the upper vertebral subgroup. Conversely, the Fmax of M-CBT group (384.20 [314.00, 851.","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}